Faces of Lower Lung Field Disease

Position of Disease
Lower Lobe distribution
Ashley Davidoff MD TheCommonvein.net lungs-0771

Infection
Inflammation

Aspiration

70F Aspiration and Pneumonia with Crazy Paving
Ashley Davidoff MD TheCommonVein.net crazy paving ICU 003

 

DIP

Coronal CT- Desquamative Interstitial Pneumonia Diffuse Ground Glass Changes with Patchy Changes more Prominent at the Lung Bases
60-year-old male smoker with a history of progressive dyspnea. Coronal CT through the posterior lung fields at the level of the vertebral column shows extensive patchy ground glass changes and mosaic attenuation. The lower lobes show more prominent parenchymal heterogeneity.
Pathology confirmed a diagnosis of DIP
Ashley Davidoff MD TheCommonVein.net 253Lu 136012

UIP

58 year old male with a family history of IPF Features on the CT reveal a dominant pattern of extensive honeycombing in the lower lobes
Ashley Davidoff MD thecommonvein.net 134902-lungs UIP


NSIP

59-year-old male presents with history of scleroderma, , Raynaud’s disease, and ILD
Coronal CT shows symmetrical bibasilar reticular change, bronchovascular thickening , ground glass changes and subpleural sparing, all features characteristic of NSIP Also note the volume loss of the lower lobes
Ashley Davidoff MD TheCommonVein.net

Inflammation Inhalation

Aspiration

70F Aspiration and Pneumonia with Crazy Paving
Ashley Davidoff MD TheCommonVein.net crazy paving ICU 003

 

Asbestosis

72 year old man with asbestosis. Chest Xray (a) shows diffuse reticular changes, dominant in the lower lobes and with a “shaggy” heart border, implying involvement of the middle lobe and lingular segments. Image b is an axial slice at the level of the main pulmonary artery and shows calcified pleural plaques in the posteromedial and right anteromedial locations. Image c of the upper lung zones show mild reticular changes and honeycomb changes. Image d shows reticular changes, more dense fibrotic changes in the lingula, thickening along right lower lobe subsegmental airway and early honeycombing
Ashley Davidoff MD thecommonvein.net 47060c01
keywords chest lung fx shaggy heart border reticular changes interstitial lung disease interstitium honeycombing pleural calcification fibrosis dx asbestosis

Malignancy Metastases

 

Renal Cell Carcinoma Metastatic to Lung CXR
54 year old male with history of right sided renal cell carcinoma.
Frontal and lateral CXR show multiple metastases to the lungs with predominant lower lung distribution. The primary lesion was an RCC. Magnified view of the left lower lobe from the frontal projection (b ringed in white) shows multiple nodular metastases with similar changes noted in the lower lobes on the magnified lateral view (d white ring)
Ashley Davidoff MD TheCommonVein.net 05769cL

 

Mechanical/Atelectasis

Trauma Metabolic

Circulatory- Pulmonary Embolus (PE)
Pulmonary Embolus Left Lower Lobe

Axial CT – Pulmonary Embolus Left Lower Lobe
56 -year-old female with a history of amyloidosis presenting with tachycardia and dyspnea. CTPA shows an occlusive embolus (PE) in the left lower lobe pulmonary artery.
Ashley Davidoff MD TheCommonVein.net 135738c

PE and No Enhancement of the Left Lower Lobe-
Dual Energy Iodine Map

Dual Energy Iodine Map–
Perfusion Defect of the Left Lower Lobe from Occlusive Pulmonary Embolus
56 -year-old female with a history of amyloidosis presenting with tachycardia and dyspnea. Dual energy CT with an iodine map shows shows an almost lobar perfusion defect of the left lower lobe compared
Ashley Davidoff MD TheCommonVein.net 135740

Hampton’s Hump –  Middle Lobe

Subsegmental Infarction in the Lateral Segment of the Middle Lobe
CXR shows a wedge shaped infiltrate in the middle lobe of the lung secondary to a pulmonary embolus (PE) characteristic of a Hampton’s hump (maroon arrowheads a,b)  The infarction is confirmed on the CT with contrast (maroon arrowhead c) as well as the region of a perfusion defect (d- maroon arrowhead) In addition there is evidence of CHF on the CXR with cephalization of the vessels (white arrowheads c) cardiomegaly with left atrial enlargement, and enlargement of the azygous vein (blue arrowhead a) 
Ashley Davidoff MD TheCommonVein.net)

Hemorrhage

Immune

Infiltrative

Idiopathic

Iatrogenic

Idiopathic